Provider Demographics
NPI:1972958502
Name:TENDER CARE SUPPORTIVE LIVING
Entity Type:Organization
Organization Name:TENDER CARE SUPPORTIVE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DELLAREESE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:414-678-8767
Mailing Address - Street 1:3746 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-4120
Mailing Address - Country:US
Mailing Address - Phone:414-678-8767
Mailing Address - Fax:
Practice Address - Street 1:3746 N 5TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-4120
Practice Address - Country:US
Practice Address - Phone:414-678-8767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIW4521768961102343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)